Billing Specialist

South Coast Children's Society•Placentia, CA

27d

About The Position

The Billing Specialist turns documented FSP-HFW services into accurate, timely Medi-Cal claims and County invoices, then follows claims through payment. Billing data is entered separately from the clinicians and direct service staff who provide and document services. The role also supports client intake and record maintenance in IRIS, insurance eligibility checks, claim corrections and follow-up, payment reconciliation, and audit-ready recordkeeping. The position requires a high school diploma or equivalent and at least two years of healthcare claims billing experience, preferably with Medi-Cal or County behavioral health (SMHS). An associate degree or medical billing certificate is preferred. The role requires County BHS New User Training, Annual Provider Training, Annual Compliance Training, and HIPAA/42 CFR Part 2 training. The salary range is $24.00–$33.00. The employer is an equal opportunity employer and considers qualified applicants without regard to protected characteristics under California law.

Requirements

High school diploma or equivalent.
At least 2 years of healthcare claims billing experience; Medi-Cal or County behavioral health (SMHS) experience is preferred.
Familiarity with CPT and HCPCS codes, CMS-1500 and 837P claims, eligibility verification, and reading 835 remittances.
Strong attention to detail.
Intermediate Excel skills.
Experience working in an EHR.
Ability to complete County BHS New User Training, Annual Provider Training, Annual Compliance Training, and HIPAA/42 CFR Part 2 training.
Ability to drive a motor vehicle without restrictions, including often in heavy traffic and frequently for long distances of one hour or more.
Vision, hearing, and smell sufficient to regularly operate a motor vehicle, visualize environmental threats, and operate safely.
Ability to occasionally lift and carry 10–20 pounds.
Ability to regularly sit, stand, climb stairs (one or more flights), and walk.
Ability to regularly sit and use a computer in office settings.

Nice To Haves

Associate degree or medical billing certificate.
Experience with Medi-Cal or County behavioral health (SMHS) billing.
Strongly preferred experience with myEvolv (Netsmart).
CPB or CMRS certification.
Experience with Orange County HCA’s IRIS system.
Bilingual English/Spanish or English/Vietnamese for eligibility follow-up with families.

Responsibilities

Obtain IRIS referral documents when a referral arrives and provide them to the Intake Specialist, including client history by MRN, Medi-Cal eligibility, Special Cohort status, and current CANS and PSC-35 status.
Check Medi-Cal eligibility and other insurance at intake and monthly, and flag lapsed or changed coverage.
Create client intake profiles in IRIS, including Special Cohort designation when applicable.
Enter CANS and PSC-35 results in IRIS and update client demographics when they change during enrollment.
Review EHR services for billing completeness, including codes, units, dates, rendering provider NPI, and location.
Enter and submit claims through the County billing system (IRIS) and 837 claim files.
Investigate denial and rejection queues, request corrections from staff when needed, and resubmit claims on time.
Correct services billed by mistake within 10 calendar days of discovery, as required by Exhibit A.
Post payments and 835 remittances, reconcile them to submitted claims, and track accounts receivable by age.
Help prepare the monthly County invoice and supporting documentation, due on the 20th.
Complete Coordination of Benefits before billing Medi-Cal.
Discharge clients in IRIS and close the episode of care (EOC) on time when they leave the program.
Maintain the rendering-provider list, including new hires’ NPIs, credentials, and taxonomy, and report NPIs to the County as soon as staff receive them.
Maintain claims, remittances, invoices, and supporting time records in an audit- and retention-ready form.
Use only the assigned IRIS token and return it when leaving or when access is no longer needed.